Recruitment

As a Tobacco Treatment Specialist, client recruitment and retention are vital for your program to be sustainable and rewarding. Client participation and retention are important in producing positive health outcomes. Client recruitment and retention are two of the most challenging issues when providing tobacco dependence treatment services.  Although recruitment and retention are different, we should keep in mind that the two are connected as part of a continuum of interaction with program participants (Anderson, 2004). 
 

Brief overview of the scientific literature on client recruitment

Currently, smoking cessation programs have little impact. When offered for free by HMOs in the United States, such programs recruit only 3% of subscribers who smoke. This type of behavioral health service cannot make much difference treating such a small percentage of the problem (Prochaska & Velicer, 1997).

Additionally, a meta-analysis evaluating whether cessation programs help, suggests that only 15% of all respondents use an assisted method of cessation during any of their attempts to quit smoking (Fiore, Novotny, Pierce, et al., 1990).  

Likewise, the results of the heart health programs in various communities have been disappointing because of low participation rates in the interventions with the highest efficacy  (Prochaska, Redding, & Evers, 1997; Prochaska & Velicer, 1997; Glasgow, Terborg, Hollis, Severson, & Boles, 1995; Lando et al., 1995; Luepker et al., 1994). Furthermore, a meta-analysis of 125 studies suggests that for psychotherapy and behavior change interventions the average retention rate is only 50% (Prochaska & Velicer, 1997).

Given the stage distribution of a population of people who use tobacco, it is clear that in order to enroll a large representative percentage into a smoking cessation program, stage-matched proactive recruitment procedures must be employed (Prochaska, Velicer, Fava, et al., 2001).
 

Barriers: Why are Tobacco Users Not Coming?

At any given time in a population, 20 percent of tobacco users are in the ready to quit stage; 40 percent are in the thinking about quitting stage; and 40 percent are in the not ready to quit stage (Prochaska, Redding, & Evers, 1997). Most tobacco cessation programs, however, are targeted mainly to the 20% of the population who are ready to quit (willing to set a quit date within the next thirty days). As a consequence, the other 80 percent of tobacco users tend to overlooked and left on their own (Prochaska, Redding, & Evers, 1997; Prochaska & Velicer, 1997).
Even of those 20 percent targeted, many have obstacles that preclude them from participating in a program. Some of the barriers faced by the tobacco user include:

• Lack of healthcare insurance
• Lack of transportation
• High cost for services and medication
• Lack of childcare
• Lack of a flexible work schedule
• High tobacco use dependence and patterns
  (Adapted from Shiffman & Gitchell, 2000; Solis, Marks, Garcia, & Shelton, 1990; Phillips, Mayer, & Aday, 2000)

Other barriers associated with a program providing the service include:

• Minimal quality control of administrative/office processes for registering clients
• Limited time periods for provision of services
• High turnover rate among tobacco treatment specialists
• Lack of culturally adapted materials and intervention
   
  

Increasing Recruitment and Retention Rates

Proactive recruitment strategies and stage-matched interventions significantly increase participation rates (Prochaska, Redding, & Evers, 1997; Prochaska & Velicer, 1997). Proactive recruitment strategies enroll tobacco users into programs that match their readiness to change stage. This includes recruiting from the 20% in the ready to quit stage and identifying the high-risk, hard to reach clients in the 40% thinking about quitting stage.
Proactive strategies include:

• Using your needs assessment
• Knowing the target audience
• Using simple recruiting strategies
• Using practical marketing strategies
• Using the ADHS-TEPP Basic Tobacco Intervention Skills certification

Stage-matching interventions compliment a proactive recruitment strategy. These interventions are matched to the tobacco users' stage. Examples of stage-matched interventions include:

• Brief interventions for those not ready to quit
• Brief informational sessions and self-help material for those thinking about quitting
• Intensive interventions for those ready to quit

Other examples include:

• Combining brief and intensive interventions for those quitting and staying quit
• Scheduled specific tobacco dependence treatment program meetings once a week with rotating topics such as nicotine dependence level, "triggers" and behavioral alternatives, and handling withdrawal symptoms